Pitfalls of HbA(1c) in the Diagnosis of Diabetes

• Type: Article in International Scientific Journal
• Date: 2020

Authors

Bergman, M (Author) Other; Abdul Ghani, M (Author) Other; Neves, JS (Author) FMUP; Monteiro, M (Author) ICBAS; Medina, JL (Author) Other; Dorcely, B (Author) Other; Buysschaert, M (Author) Other

Journal

Title: Journal of Clinical Endocrinology and Metabolism

Vol. 105

Pages: 2803-2811

ISSN: 0021-972X

Publisher: Endocrine Society

Indexing

ISI Web of Knowledge - 4 Citations

Scopus - 5 Citations

Other information

Authenticus ID: P-00S-CP8

DOI: 10.1210/clinem/dgaa372

Abstract (EN): Many health care providers screen high-risk individuals exclusively with an HbA(1c) despite its insensitivity for detecting dysglycemia. The 2 cases presented describe the inherent caveats of interpreting HbA(1c) without performing an oral glucose tolerance test (OGTT). The first case reflects the risk of overdiagnosing type 2 diabetes (T2D) in an older African American male in whom HbA(1c) levels, although variable, were primarily in the mid-prediabetes range (5.7-6.4% [39-46 mmol/mol]) for many years although the initial OGTT demonstrated borderline impaired fasting glucose with a fasting plasma glucose of 102 mg/dL [5.7 mmol/L]) without evidence for impaired glucose tolerance (2-hour glucose >= 140-199 mg/dL ([7.8-11.1 mmol/L]). Because subsequent HbA(1c) levels were diagnostic of T2D (6.5%-6.6% [48-49 mmol/mol]), a second OGTT performed was normal. The second case illustrates the risk of underdiagnosing T2D in a male with HIV having normal HbA(1c) levels over many years who underwent an OGTT when mild prediabetes (HbA(1c) = 5.7% [39 mmol/mol]) developed that was diagnostic of T2D. To avoid inadvertent mistreatment, it is therefore essential to perform an OGTT, despite its limitations, in high-risk individuals, particularly when glucose or fructosamine and HbA(1c) values are discordant. Innate differences in the relationship between fructosamine or fasting glucose to HbA(1c) are demonstrated by the glycation gap or hemoglobin glycation index.

Language: English

Type (Professor's evaluation): Scientific

No. of pages: 9